Orexigenic Agents in Geriatric Clinical Practice

Vishal Viswambharan; Jothika N Manepalli; George T Grossberg


Aging Health. 2013;9(1):49-65. 

In This Article

Review of the Evidence: Levels of Evidence

For this article, a comprehensive literature review via PubMed and Medline was performed. Although a simple PubMed search with the terms 'orexigenics' and 'elderly' yielded 122 articles, the articles on the use of specific orexigenic agents in the elderly population were limited. The other relevant search terms were: weight loss, nursing home, appetite stimulants, mirtazapine, dronabinol, megesterol acetate, cyproheptadine, tricylic antidepressants (TCAs), ornithine oxoglutarate, oxandrolone, growth hormone, ghrelin, testosterone and metoclopramide. Any studies or reviews dealing with the use of orexigenics/appetite stimulants specifically in the elderly were focused on, in addition to reviews on appetite stimulants in HIV, AIDS and cancer populations. The recommendations mentioned in this paper are based on the levels of evidence published by the US Preventive Services Task Force.[205] Although several orexigenic agents are available, none of them have been validated in the treatment of IWL in the elderly population.[34] Before initiating treatment with orexigenic agents, the etiology of weight loss, as well as patients' goals of care. Although widely prescribed in people with end-stage dementia, orexigenic agents may not be as effective compared with other therapeutic agents used in this subgroup, owing to the lack of significant improvement in the patients' 'sense of well being'.[20,27] Most of the evidence for the use of orexigenic agents involves younger patients with AIDS and cancer. Very few trials are available validating the use of these mediations in the elderly population. In this article, the authors identified all published reports on the use of orexigenic agents for the treatment of appetite/weight loss and known adverse events associated with these drugs.